Bucs/NFL

Doctors can face difficult decisions

Physicians often feel trapped between the interests of the team, which pays his salary, and player, who desperately wants to return to action.

By DAVE SCHEIBER
Published September 28, 2006

Players and coaches aren't the only ones performing under intense pressure in the course of an NFL game. So are team doctors, and according to a former physician for the Raiders, they often are caught in the middle.

Rob Huizenga, the Raiders' team doctor from 1983-90, says one of the most challenging situations for team doctors involves diagnosing players who don't want to admit they're hurt or insist on playing because their starting job and paycheck might hang in the balance.

"It's very, very tough," said Huizenga, author of the book, You're Okay, It's Just A Bruise: A Doctor's Sideline Secrets About Pro Football's Most Outrageous Team. "Because if the player was the type of person who when injured would acknowledge that and always take themselves out, they probably wouldn't have gotten to this level of competition."

In the case of Bucs quarterback Chris Simms and the ruptured spleen he sustained Sunday, his problems appeared initially to be the result of bruising hits and dehydration.

It might never be known what caused the damage to his spleen, an injury doctors say can be hard to detect because the symptoms mirror dehydration. But it's clear Simms wanted to tough it out after heading to the locker room in pain in the third quarter with team doctor Joe Diaco, receiving intravenous fluids and returning to action.

Huizenga, now a clinical professor of medicine at UCLA, says it's impossible to second-guess the decision to send Simms back into the game, "because none of us were there to know exactly what was happening."

"You had the right doctor for the right situation," he added. "Diaco is a surgeon, and this is his specialty, spleen issues. He's got a surgical background ... and this is the kind of surgical emergency that they're trained for."

Huizenga once almost cleared a Raider who was having an appendicitis.

"The guy was having abdominal pain and going back and forth," he said. "It's very difficult when a player is insisting that they're fine and there are equivocal findings."

But to Huizenga, the larger issue is many team doctors can be overly beholden to coaches and those who employ them.

"You've got excellent doctors ... who are in a very bad, dicey situation," he said.

"It would be nice if there were a situation where the doctor could make a unilateral decision: 'You could not go back into the game,' " But that's really not how NFL football is practiced. A doctor can make that suggestion, but that's really not the final determinant. It's not like in boxing where if the doctor says the fight's over, the fight's over. Even if the doctor demands that the player not play, that's not necessarily what's going to happen."

Huizenga cites a 2002 game in which Donovan McNabb hurt his ankle on the third play then limped while throwing four touchdowns. What was believed to be a sprain was diagnosed as a break.

"Most teams can probably say you're not going back in," he said. "But look at the McNabb situation. The coach (Andy Reid) makes the medical decisions on that team in that year. It was not the team doctor."

The issue is one of accountability says Huizenga, past president of the NFL Physicians Society who says he has been "persona non grata" with the organization since his book came out in 1995.

"The question is, what are the qualifications of the team doctor and who does the team doctor respond to. It's very difficult when your check is being paid by the owner. You're not being sponsored by an independent organization like boxing doctors who are hired and paid for by a state commission.

"You're not really answering to your patient. You're answering to the person who's hired you and they, of course, have an agenda. And it puts the doctor under tremendous pressure."

Players can feel it in a big way as well.

"If a doctor says, 'Can you play?' the guy has got to say yes, otherwise he's a wuss," Huizenga said.

Koco Eaton, orthopedic physician of the Devil Rays, says "the athlete has a lot to prove, like, 'I'm not going to be soft. I'm not going to have anyone say I can't weather the storm.' The athlete himself is under pressure to go all out, even though he's hurting, to continue to perform.'

"The problem with being a team doctor is that just as everyone's a Monday morning quarterback, everyone is a Monday morning team doctor who wants to criticize and blame the team doctor. But I think it's probably the toughest job to do. You always want to think beyond the moment, beyond the game and what is the safest, healthiest thing for this player."

[Last modified September 28, 2006, 11:08:45]